A score to predict short-term risk of COPD exacerbations (SCOPEX)

Barry J. Make, Göran Eriksson, Peter M. Calverley, Christine R. Jenkins, Dirkje S. Postma, Stefan Peterson, Ollie Östlund, Antonio R Anzueto

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting β2-agonist (salbutamol). Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk.

Original languageEnglish (US)
Pages (from-to)201-209
Number of pages9
JournalInternational Journal of COPD
Volume10
DOIs
StatePublished - Jan 27 2015

Fingerprint

Chronic Obstructive Pulmonary Disease
Disease Progression
Budesonide
Time and Motion Studies
Albuterol
Vital Capacity
Sex Ratio
Forced Expiratory Volume
Statistical Models
ROC Curve
Placebos
Maintenance
Observation
Clinical Trials
Formoterol Fumarate
Therapeutics

Keywords

  • Bronchodilators
  • Chronic obstructive pulmonary disease
  • Exacerbation
  • Inhaled corticosteroids
  • Model
  • Predictor

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

Make, B. J., Eriksson, G., Calverley, P. M., Jenkins, C. R., Postma, D. S., Peterson, S., ... Anzueto, A. R. (2015). A score to predict short-term risk of COPD exacerbations (SCOPEX). International Journal of COPD, 10, 201-209. https://doi.org/10.2147/COPD.S69589

A score to predict short-term risk of COPD exacerbations (SCOPEX). / Make, Barry J.; Eriksson, Göran; Calverley, Peter M.; Jenkins, Christine R.; Postma, Dirkje S.; Peterson, Stefan; Östlund, Ollie; Anzueto, Antonio R.

In: International Journal of COPD, Vol. 10, 27.01.2015, p. 201-209.

Research output: Contribution to journalArticle

Make, BJ, Eriksson, G, Calverley, PM, Jenkins, CR, Postma, DS, Peterson, S, Östlund, O & Anzueto, AR 2015, 'A score to predict short-term risk of COPD exacerbations (SCOPEX)', International Journal of COPD, vol. 10, pp. 201-209. https://doi.org/10.2147/COPD.S69589
Make BJ, Eriksson G, Calverley PM, Jenkins CR, Postma DS, Peterson S et al. A score to predict short-term risk of COPD exacerbations (SCOPEX). International Journal of COPD. 2015 Jan 27;10:201-209. https://doi.org/10.2147/COPD.S69589
Make, Barry J. ; Eriksson, Göran ; Calverley, Peter M. ; Jenkins, Christine R. ; Postma, Dirkje S. ; Peterson, Stefan ; Östlund, Ollie ; Anzueto, Antonio R. / A score to predict short-term risk of COPD exacerbations (SCOPEX). In: International Journal of COPD. 2015 ; Vol. 10. pp. 201-209.
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AU - Postma, Dirkje S.

AU - Peterson, Stefan

AU - Östlund, Ollie

AU - Anzueto, Antonio R

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N2 - Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting β2-agonist (salbutamol). Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk.

AB - Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting β2-agonist (salbutamol). Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk.

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